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On the last track, we discussed definitions, symptoms,
and treatment challenges regarding your client who has a Borderline Personality
On this track, we will examine how schemas affect
everyday lives: as a way to view the world; and a stored response to an emotionaltrauma. Also, we will address various maladaptive schemas that characterize many
BPD diagnosed clients: selective perception; overgeneralization; and jumping to
As you may know, schemas refer
to the way your client views the world. Many times, these schemas are beliefs
instilled during an early developmental stage. They give a single way of seeing
and thinking about the world. However, they also inhibit clients from flexingtheircreativity by confining thoughts along arbitrary lines.
Louisa, 32, diagnosed
with Borderline Personality Disorder, developed her own schema of not belonging
while growing up. She stated, "I grew up on a small town in Iowa, about two
thousand people. The luckiest girls lived in town. They could go to the drugstore
together after school and get a soda. I couldn't do that; my mother made me stay
in my room most of the time. God, even when I was a little kid, like eight years
old, she was afraid some guy was going to knock me up. I've always felt outside
of things. Apart from everyone. I don't trust anybody, including you."
you can see, Louisa's early experience of being isolated instilled in her the
schema of exclusion, which as you know is typical of BPD diagnosed clients. Louisa
continued, "It boiled down to my belief that those other girls were thinking,
'You're not like us, and we don't like you.' I hate those bitches!"
The Amygdala's Schemas
Now let's look at the way in which a schema first takes hold for the BPD diagnosed
client. The region of the brain responsible for inherent schemas is the amygdala
. When a client experiences a trauma, such as abandonment early in life, and
reacts in a certain way, the amygdala registers the emotions felt during the trauma
and the reaction.
Therefore, when later in life a client experiences a feeling
of abandonment again, the amygdala reacts in a split second and favors the primary
reaction it learned early in development. Because the amygdala reacts much faster
than the neocortex, or the reasoning portion of the brain, the client, if their
primary response was anger, acts angrily without the information having been sorted
through yet. However, once the information has reached the reasoning portion of
the brain, the client looks back on the incident and many times regrets their
Thinking of Your BPD Client in the Construct of Brain Patterns
I like to think of the client diagnosed with BPD
that I see in terms of schemas and how it relates to the functioning of the amygdala
because it depersonalizes the attacks I receive from this type of client, as you
will see. Rather than thinking of the client as having selective perceptions and
being perfectionist, the concept of schemas helps to keep me from burning out
with this client population by thinking of their remarks, behaviors, and backslides
in the construct of brain patterns. Would thinking of your client diagnosed with
BPD in the construct of brain patterns assist in decreasing your BPD burn out?
In my practice, I have found the client diagnosed with BPD exhibits
three maladaptive schemas which cause the most social havoc for them.
Schema 1: Selective Perception
maladaptive schema is selective perception. This occurs when the client sees things
in only one way, while discounting evidence to the contrary. This schema was exhibited
by Trisha, age 23, diagnosed with BPD.
Trisha was attempting to be a competitive
ice skater and practiced for countless hours to perfect her moves. During the
most important competition of her career, Trisha lost her footing and fell. Even
though the rest of Trisha's routine was perfect, that one flaw was what she focused
on and so did the rest of the audience. Trisha said, "They expected perfection from me and I let them down." I pointed out to Trisha that the majority of
her performance was flawless and she responded, "It doesn't matter. I am
just no good. That one bullshit mistake was all that the judge, the announcer,
and the whole stadium saw. I was so ashamed, but then I hate them for judging
me. All my work, every single bit of it just down the toilet."
As you can
see, Trisha was suffering from selective perception, viewing only her one flaw and interpreting it as complete and utter failure. Such thinking caused Trisha
to go into a loop of self-criticism, refusing to give herself credit for any other
accomplishments because she had made a mistake.
Schema 2: Overgeneralization
This loop leads to overgeneralization,
another maladaptive schema that the client diagnosed with BPD has. This schema
is characterized by a single event being interpreted as a perpetualpattern. Trisha
would say, "I can never get this right" and "I'll never be good
Schema 3: Jumping to Conclusions
A third schema that clients diagnosed with BPD
exhibit is known as jumping to conclusions. As you know, this occurs when a client
concludes their worst beliefs are valid, despite the lack of evidence.
for example, related this story to me. "I once had a boyfriend I had met
when we both worked for the same company. After several months, we broke up. Two
weeks after our breakup, I saw him pull into the parking lot and there was a woman
in the car with him. I was hurt and furious. I thought, 'God damnit, they've slept
together. He's done this to me already!' I felt completely betrayed, even though
I had already started dating another man. I stormed right in front of his car,
seething, yelled everything in the book at the top of my lungs at them, gave them
the finger, and made sure he could see me. Then I stalked into the building and
slammed as many doors as I could find. I later found out that he and the woman
weren't together at all. He had just given her a lift because her car broke down
on the way to work."
Alicia's reaction, as you can see, jumped to the conclusion
that her ex had already replaced and this drove her into a rage, even though she
had done the same thing to him.
Exercise: 4 "Reaction Analysis"Questions
To help Trisha and Alicia better understand their maladaptive
schemas of selective perceptions, overgeneralizations, and jumping to conclusions,
I found the "Reaction Analysis" Questions beneficial. In this exercise,
I asked Trisha and Alicia to recognize their ingrained schemas. Then, when they
felt they had enacted a schema, I asked them to answer several questions that
evaluated their reaction.
These questions included: 1. Ask your client if their reaction was beneficial to facilitate them meeting their
goal. For example, the goal for Trisha and Alicia, they stated, was enjoying ice
skating or maintaining relationships. I tactfully asked Trisha and Alicia, "Did
the resulting interaction work out well, or did their thoughts, intense feelings,
or reactions leave them feeling upset?" 2. Each schema, such as selective
perceptions, overgeneralizations, and jumping to conclusions, has it's unique
triggers, so the situation that sets a client diagnosed with BPD off is another
clue to which schema might be involved. In short, find the schema, find the trigger.
What was your client's schemas and triggers? 3. Each schema has its
own distinctive emotional flavor. You can identify whatever schema may be at play
by identifying your client's visceral or primitive reactions. What was your client
feeling? 4. What did your client do?
As a response
to this exercise, for Alicia's overreaction to her ex-boyfriend, she stated, "I
let myself become overpoweredwithrage. I felt betrayed and angry. Afterwards,
I felt so ashamed and rash. I felt like I had reacted like an adolescent school
girl whose crush rejected her. That's not the level of maturity I want. I think
I may be suffering from a jump-to-conclusions schema."
analyzing her reaction, Alicia began to identify her schema of jumping to conclusions
and to better address when it struggled to surface again.
this track, we have discussed how schemas affect everyday lives: as a way to view
the world and a stored response to an emotional trauma. Also, we addressed various
maladaptive schemas that characterize many clients diagnosed with BPD: selective
perception, overgeneralization, and jumping to conclusions.
the next track, we will discuss pattern schemas and BPD.
Feasibility of Group Schema Therapy for Outpatients with
Severe Borderline Personality Disorder in Germany:
A Pilot Study with Three Year Follow-Up
- Fassbinder E, Schuetze M, Kranich A, Sipos V, Hohagen F, Shaw I, Farrell J, Arntz A, and Schweiger U. (2016). Feasibility ofGroup Schema Therapy for Outpatients with Severe Borderline Personality Disorder in Germany: A Pilot Study with Three Year Follow-Up.
Front. Psychol. 7:1851. doi: 10.3389/fpsyg.2016.01851
Peer-Reviewed Journal Article References:
Houben, M., Vansteelandt, K., Claes, L., Sienaert, P., Berens, A., Sleuwaegen, E., & Kuppens, P. (2016). Emotional switching in borderline personality disorder: A daily life study.Personality Disorders: Theory, Research, and Treatment, 7(1), 50–60.
Liebke, L., Koppe, G., Bungert, M., Thome, J., Hauschild, S., Defiebre, N., Izurieta Hidalgo, N. A., Schmahl, C., Bohus, M., & Lis, S. (2018). Difficulties with being socially accepted: An experimental study in borderline personality disorder.Journal of Abnormal Psychology, 127(7), 670–682.
Miano, A., Fertuck, E. A., Roepke, S., & Dziobek, I. (2017). Romantic relationship dysfunction in borderline personality disorder—a naturalistic approach to trustworthiness perception.Personality Disorders: Theory, Research, and Treatment, 8(3), 281–286.
Online Continuing Education QUESTION
3 What are three maladaptive schemas prevalent in Borderline Personality
disorder clients? To select and enter your answer, go to CE Test.